Moderate Drinking May Ease Disability from Chronic Pain

Greatest benefit reported by those who consumed three to five drinks daily

Action Points

Alcohol consumption is inversely associated with prevalence and severity of chronic widespread pain according to a U.K. study.

Note that current data do not determine whether the association between alcohol consumption and chronic widespread pain is causal.

Patients with chronic widespread pain (CWP) who consume moderate amounts of alcohol have lower levels of disability, according to a large new population-based study from the United Kingdom.

The research doesn't determine whether the relationship between alcohol consumption and CWP is causal although the magnitude of the association suggests further study is needed, according to Gary J. MacFarlane, PhD, MD, Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Scotland, and colleagues.

A smaller U.S. study previously showed that in patients with fibromyalgia, moderate alcohol consumption was associated with reduced symptom severity and increased quality of life. However, the current study also linked alcohol consumption with the likelihood of reporting CWP.

The study used data from a previously conducted epidemiological study (MUSICIAN), a randomized controlled trial that compared telephone-delivered cognitive behavioral therapy (CBT) and a community-based exercise program with usual care. Subjects were from the city of Aberdeen in Scotland or the more rural area of North Cheshire in England.

Using information collected in a survey, researchers identified subjects who reported pain that satisfied the definition of CWP used by the American College of Rheumatology (ACR). From responses to the Chronic Pain Grade scale, they determined the level of disability among subjects – from grade I (low disability; low intensity) to IV (high disability; severely limiting).

Participants reported their average consumption of alcohol per week. One unit of alcohol equals half a pint of beer or lager, a small glass of wine, or a single measure of spirits.

Researchers used the Carstairs Index, which includes socio-economic status indicators, to estimate "deprivation".

The overall analysis included 13,574 subjects, mean age 55 years. Of these, 16.5% satisfied the ACR definition of CWP. In the sample, 28% reported never regularly drinking alcohol, 28% reported consuming an average of up to 5 units/week, 20% 6-10 units per week; 15% 11-20 units per week; 7% 21-35 units per week; and 2% more than 35 units per week.

In those with CWP, the percentage of subjects with disabling pain decreased with increasing alcohol consumption – from 47.2% among those who didn't drink regularly to only 18.6% among those who drank 21-35 units/week. The difference, noted the authors, remained highly statistically significant after adjusting for confounders such as age, gender, employment, smoking, and body mass index, with an adjusted odds ratio (OR) of 0.33 (95% CI 0.19-0.58).

In the highest alcohol consumption category -- 35 units per week -- the proportion with disabling pain was similar to those who didn't drink regularly.

The relationship was similar for both men and women, but the lowest disability was at 11-20 units/week in females and 21-35 units/week in males.

Similar patterns for the relationship between alcohol consumption and disability were seen among the 8983 subjects for whom Carstairs Index information was available.

The authors reported, for the first time, that the level of alcohol consumption was also related to the likelihood of reporting CWP -- and not just to its severity.

The prevalence of CWP also decreased with increasing alcohol use: from 19.8% in those not drinking alcohol regularly to 13.1% in those consuming 11-20 units/week (adjusted OR 0.75, 95% CI 0.64-0.88) or 21-35 units/week (adjusted OR 0.76; 95% CI 0.61-0.94). The CWP prevalence among the highest consumers of alcohol was similar to non-regular drinkers.

According to the authors, the levels of alcohol consumption reported by study subjects were in line with national surveys. The maximum recommended alcohol consumption in the UK is 21 units/week for men and 14 units/week for women.

The authors noted that their study lacks data on some potential confounders that might have shed additional light on the link between alcohol and chronic pain. "Ideally we would have had lifestyle factors (e.g., exercise) and individual characteristics (e.g., depression) known to be markers of CWP onset and which are known to be related to alcohol consumption," they wrote.

The new analysis adds weight to the previous study. However, the two studies were conducted in different countries, used different sampling frames (fibromyalgia treatment program versus a population study), defined the outcome differently and collected information on alcohol consumption in different ways.

Authors of the previous study discussed possible mechanisms linking alcohol consumption with reduced disability. One is that ethanol enhances GABA release in the brain.

In this new paper, researchers noted that alcohol has been reported to improve other areas of health, including mood, quality of life, and physical health. According to some research, mortality rates from cardiovascular disease are significantly lower among men and women who consume at least one drink daily compared to non-drinkers, although this isn't the case for heavy drinkers among whom mortality rates increase.

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